The North American Menopause Society Recommendations for Clinical Care of Midlife Women

Jan L Shifren, MD, NCMP, Margery LS Gass, MD, NCMP, for the NAMS Recommendations for Clinical Care of Midlife Women Working Group


Menopause. 2014;21(10):1038-1062. 

In This Article

Chapter 6: Complementary and Alternative Medicine

Integrative Medicine

Key Points

1. A National Institutes of Health survey found that 36% of Americans use some form of complementary and alternative medicine (CAM). When megavitamin use and prayer for health reasons are included in the definition of CAM, the percentage rises to 62%.

2. Increased dietary soy (legumes, soy, tofu), isoflavone products, and other forms of phytoestrogens reduce menopause symptoms, although clinical trials demonstrate benefit generally similar to that of placebo.

3. Acupuncture reduces hot flashes and improves sleep patterns in postmenopausal women, although clinical trials demonstrate benefit generally similar to that of sham acupuncture.

4. Regular consumption of soy isoflavones in the diet may offer breast cancer protection if exposure occurs during breast development. Soy isoflavones also may inhibit the progression of atherosclerosis if initiated within 5 years after the onset of menopause.

Recommendations for Clinical Care

1. Healthcare providers should ask midlife women about CAM usage and utilize available resources to guide them regarding the efficacy and safety of available treatments. (Level III)

2. CAM approaches, including acupuncture, herbal products, dietary soy, and isoflavone products, may be offered to treat vasomotor symptoms, although clinical trials generally demonstrate benefit for menopausal symptoms similar to that of placebo. (Level II)

3. There are no data that soy, phytoestrogens, or isoflavone products increase the risk of breast or endometrial cancer, although women with breast or endometrial cancer should consider consulting their oncologists before using them. (Level II)


Key Points

1. Marketed herbal products are regulated in the United States as dietary supplements. Many manufacturers employ rigorous quality-control measures and produce high-quality products, whereas others produce poorer-quality products with regard to purity and levels of active compounds.

2. The German Federal Institute for Drugs and Medical Devices approved black cohosh for menopause-related complaints, premenstrual syndrome, and dysmenorrhea. Although several of the plant's constituents have been identified, its precise mechanism of action is unknown.

3. St. John's wort, also known as Hypericum perforatum, is the most popular herbal treatment for mild depression. Several studies of St. John's wort showed improvement in mood and anxiety disorders in perimenopausal and postmenopausal women. The herb kava also may reduce anxiety.

4. The efficacy of black cohosh for the treatment of hot flashes is similar to that of placebo.

5. Vitex, also known as chasteberry, is commonly used for premenstrual syndrome, irregular menstruation, and cyclical mastalgia.

Recommendations for Clinical Care

1. Because some herbal products may affect the metabolism of drugs or increase bleeding, healthcare providers should ask midlife women about their use of herbal remedies and dietary supplements, particularly if a medical procedure or drug therapy is planned. (Level II)

2. St John's wort may be advised for mild mood symptoms in midlife women. (Level II)